Provider Demographics
NPI:1659965531
Name:MARBLE CITY DENTISTRY & FACIAL ESTHETICS
Entity Type:Organization
Organization Name:MARBLE CITY DENTISTRY & FACIAL ESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZELWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-888-8999
Mailing Address - Street 1:800 S GAY ST STE P325
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37929-9749
Mailing Address - Country:US
Mailing Address - Phone:865-888-8999
Mailing Address - Fax:865-200-8000
Practice Address - Street 1:800 S GAY ST STE P325
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37929-9749
Practice Address - Country:US
Practice Address - Phone:865-888-8999
Practice Address - Fax:865-200-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty